Provider Demographics
NPI:1689066078
Name:HILBURN, SHAUN R (DPT)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:R
Last Name:HILBURN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15410 S MOUNTAIN PKWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6691
Mailing Address - Country:US
Mailing Address - Phone:480-689-5509
Mailing Address - Fax:480-706-7997
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD
Practice Address - Street 2:SUITE 126
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4259
Practice Address - Country:US
Practice Address - Phone:480-840-6125
Practice Address - Fax:480-940-6122
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11426225100000X
2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic